Exploring the impact of efficacy messages on cessation-related outcomes using Ecological Momentary Assessment

Introduction: Observational studies indicate that cigarette package inserts withefficacy messages about the benefits of quitting (i.e. response efficacy) andrecommendations for successful cessation increase smokers’ self-efficacy toquit and promote sustained cessation. However, the effects of inserts with suchefficacy messages have not been studied using experimental designs. This studyused ecological momentary assessment (EMA) to assess smokers’ responses toefficacy inserts.Methods: In a randomized case-crossover study among smokers from the UnitedStates (n=23), participants received a one-week supply of cigarettes with efficacyinserts and a one-week supply without any inserts, and were randomized to usethe packs with inserts on either the first or second week of the study. For 14consecutive days, participants used a smartphone to answer brief surveys oncessation-related variables during smoking sessions and at the beginning of eachday. Multilevel mixed-effects linear and logistic regression models comparedresponses during the insert period to those of the non-insert period.Results: The insert period was associated with greater desire to quit (b=0.21,p=0.012), motivation to quit (b=0.18, p=0.001), self-efficacy to cut down(b=0.26, pConclusions: Results from this EMA study suggest that inserts with efficacymessages may promote determinants of smoking cessation. This is consistentwith observational research in Canada, which is the only country to use insertswith efficacy messages as well as pictorial warnings about smoking risks onthe outside of packs. Future studies should assess the extent to which efficacyinserts can not only be used to communicate health information to smokers butalso work in synergy with pictorial warnings